09/09/15 – Perioperative Temperature Management


Question: While using active warming, the patient’s body temperature measurement was equal to or greater than 96.8 degrees Fahrenheit.  The temperature was taken within the designated timeframe for a general anesthesia case that lasted 47 minutes.  Should I report G9363 only?

Answer: Yes, you can use code G9363 (Duration of monitored anesthesia care [MAC] or peripheral nerve block [PNB] without the use of general anesthesia during an applicable procedure or general or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia record).

Refresher: This code applies for all patients, regardless of age, undergoing surgical or therapeutic procedures under general or neuraxial anesthesia of 60 minutes duration or longer, except patients undergoing cardiopulmonary bypass.


Other codes are for patients who meet one of two criteria:

  • Active warming was used intraoperatively for the purpose of maintaining normothermia; or


  • At least one body temperature equal to or greater than 36 degrees Centigrade (or 96.8 degrees Fahrenheit) was recorded within the 30 minutes immediately before or the 15 minutes immediately after anesthesia end time.

The anesthesia time used for this measure should be the time recorded in the anesthesia record.



CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10

Published July 6, 2015


With less than three months remaining until the nation switches from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures, The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) are announcing efforts to continue to help physicians get ready ahead of the October 1 deadline. In response to requests from the provider community, CMS is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set.


Recognizing that health care providers need help with the transition, CMS and AMA are

working to make sure physicians and other providers are ready ahead of the transition to ICD-10 that will happen on October 1. Reaching out to health care providers all across the country,

CMS and AMA will in parallel be educating providers through webinars, on-site training, educational articles and national provider calls to help physicians and other health care providers learn about the updated codes and prepare for the transition.


“As we work to modernize our nation’s health care infrastructure, the coming implementation of ICD-10 will set the stage for better identification of illness and earlier warning signs of epidemics, such as Ebola or flu pandemics.” said Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services. “With easy to use tools, a new ICD-10 Ombudsman, and added flexibility in our claims audit and quality reporting process, CMS is committed to working with the physician community to work through this transition.”


“ICD 10 implementation is set to begin on October 1, and it is imperative that physician practices take steps beforehand to be ready,” said AMA President Steven J. Stack, MD. “We appreciate that CMS is adopting policies to ease the transition to ICD-10 in response to physicians’ concerns that inadvertent coding errors or system glitches during the transition to ICD-10 may result in audits, claims denials, and penalties under various Medicare reporting programs. The actions CMS is initiating today can help to mitigate potential problems. We will continue to work with the administration in the weeks and months ahead to make sure the transition is as smooth as possible.”


The International Classification of Diseases, or ICD, is used to standardize codes for medical conditions and procedures. The medical codes America uses for diagnosis and billing have not been updated in more than 35 years and contain outdated, obsolete terms.


The use of ICD-10 should advance public health research and emergency response through detection of disease outbreaks and adverse drug events, as well as support innovative payment models that drive quality of care.


CMS’ free help includes the “Road to 10” aimed specifically at smaller physician practices with primers for clinical documentation, clinical scenarios, and other specialty-specific resources to help with implementation. CMS has also released provider training videos that offer helpful ICD-10 implementation tips.


The AMA also has a broad range of materials available to help physicians prepare for the

October 1 deadline. To learn more and stay apprised on developments, visit AMA Wire.

CMS also detailed its operating plans for the ICD-10 implementation. Upcoming milestones include:


  • Setting up an ICD-10 communications and coordination center, learning from best practices of other large technology implementations that will be in place to

identify and resolve issues arising from the ICD-10 transition.

  • Sending a letter in July to all Medicare fee-for-service providers encouraging

ICD-10 readiness and notifying them of these flexibilities.

  • Completing the final window of Medicare end-to-end testing for providers this


  • Offering ongoing Medicare acknowledgement testing for providers through

September 30th.

  • Providing additional in-person training through the “Road to 10” for small physician practices.
  • Hosting an MLN Connects National Provider Call on August 27th.


In accordance with the coming transition, the Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of services after September 30, 2015, nor will they be able to accept claims for both ICD-9 and ICD-10 codes.


Also, at the request of the AMA, CMS will name a CMS ICD-10 Ombudsman to triage and answer questions about the submission of claims. The ICD-10 Ombudsman will be located at CMS’s ICD-10 Coordination Center.



Transition to ICD-10: Don’t focus on the family — CMS revisits FAQ to emphasize ICD-10 rules

As published by DecisionHealth, by Julia Kyles, CPC-A, August 13, 2015


An unspecified ICD-10 diagnosis code might save a claim from a post-payment audit, but it must be valid to get through the initial submission phase, CMS emphasized in its July 31 revision to a Q&A on its ICD-10 safe harbor (see story, New CMS ICD-10 Q&A emphasizes requirements for valid codes). The update contains new examples to answer lingering questions about the level of specificity required on claims and how the “family of codes” impacts coding.


For example, CMS notes that to diagnose migraine the provider must select a code from the correct family — G43 rather than G44 (Other headache syndromes) or R51 (Headache) — and then select a valid, six-character code:


“A patient has a diagnosis of G43.711 (Chronic migraine without aura, intractable, with status migrainosus). Use of the valid codes G43.701 (Chronic migraine without aura) or G43.719 (Chronic migraine without aura, intractable without status migrainosus) instead of the correct code, G43.711, would not be cause for an audit under the audit flexibilities occurring for 12 months after ICD-10 implementation, since they are all in the same family of codes,” CMS says.

CMS also urged providers to “practice identifying and using valid codes as part of acknowledgment testing with Medicare, available through Sept. 30, 2015.” Anyone may conduct an acknowledgment test with their Medicare administrative contractor (MAC) at any time before the transition.


3 safe harbor tips to share

The safe harbor announcement has generated a lot of interest and not a little confusion. Here are three tips to share with staff:

  1. Claims reviewed during a post-payment audit are covered by the safe harbor.
  2. The safe harbor does not cover initial claims submissions, pre-payment audits and prior authorizations. Your MAC may deny claims when a more specific code is necessary.
  3. The safe harbor applies only to Part B services paid under the physician fee schedule.


Proposed fee schedule: Remember to comment – CMS to reconsider cataract surgery, drug screen codes

As published by DecisionHealth, by Julia Kyles, CPC-A, August 13, 2015


You have until Sept. 8 to comment on the 2016 physician fee schedule. And keep an eye on CMS’ laboratory public meeting webpage. The agency has already posted proposed clinical lab codes and intends to post its preliminary determinations for the 2016 clinical lab fee schedule in September. It will accept comments until October. That information had not been posted when this issue of APCPS went to press.


Here are some additional changes that will impact anesthesia providers and practices that provide in-house drug screens:

  • Anesthesia for cataract services could disappear — Anesthesia providers could lose the ability to bill for cataract services, warns Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, president, Perfect Office Solutions, Leesburg, Fla. The agency is seeking comments on the implications of making most cataract surgery an in-office procedure. “We believe that it is now possible for cataract surgery to be furnished in an in-office surgical suite, especially for routine cases,” says CMS and notes that anesthesia for cataract surgery is usually “local or topical/intracameral.” However, anesthesia for lens surgery (00142) remains the most commonly reported anesthesia code for Medicare patients, according to the latest utilization data.
  • Anesthesia for upper and lower GI endoscopy revisited — One year after it included anesthesia in the definition of a screening colonoscopy, CMS will take a look at payments for services performed with upper (00740) and lower gastrointestinal endoscopy (00810), Dennis says. Based on an increase in utilization, CMS proposes to identify the codes as “potentially misvalued.”
  • Neurostimulator evaluation payments up for inspection — In addition to a new payment policy for neurostimulator implants (APCPS 6/14, 10/14), you could see changes to the payment for evaluation services such as 95972. CMS intends to put these codes on the potentially misvalued list.
  • Two drug screen codes could cover all services — Medicare intends to make its most drastic move to curb overutilization of drug screen coding. It proposes to delete all 30 of its current drug screen codes and replace them with two codes that may be reported once, per patient, per day. The descriptor for the new codes would be:
  1. Drug screen, any number of drugs or drug classes, any procedure(s)/methodology(ies), any source(s), per day.
  2. Drug test(s) (confirmatory and/or definitive, qualitative and quantitative), any number of drugs or drug classes, any procedure(s)/methodology(ies), any source(s), includes sample validation, per day.

Based on the history of drug screen coding, you could expect some of your private payers to follow Medicare’s lead and adopt those codes.


You may submit comments for the proposed physician fee schedule at www.regulations.gov.

Watch the CMS website and upcoming issues of APCPS for information on when to submit comments on the clinical lab fee schedule.



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